Kiran Bajaj, Raja Taha Yaseen Khan*, Abbas Ali Tasneem, Hina Ismail, Adeel Ur Rehman Siddiqui, Manzoor ul Haq, Syed Mudassir Laeeq, Farina M Hanif and Nasir Hasan Luck
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, PakistanFulltext PDF
Introduction: The elasticity of the lesion is measured by means of Endoscopic Ultrasound guided elastography (EUS-elastography). Strain Ratio (SR), calculated with EUS, has been proposed in previous studies to differentiate between malignant and benign lesions including LNs. SR may not only improve the accuracy of diagnosing malignant tissue but can also be helpful in attaining targeted biopsies. Moreover, it can access abdominal LNs not approachable by percutaneous route. Our aim was to assess the diagnostic accuracy of strain ratio on EUS-elastography in detecting malignant lymph nodes and differentiating benign from malignant abdominal Lymph Nodes (LNs).
Methods: It was a cross-sectional prospective study. All patients 18 to 60 years undergoing EUS for abdominal lymphadenopathy were enrolled in our study. Patient’s demographics, such as age, duration of disease were recorded. Patients who were underwent EUS were administered. EUS was performed after an overnight fast of 8 h by consultant gastroenterologist. EUS-SR elastography
calculated. Statistical analysis was performed by SPSS 20.0.
Result: In total 106 patients were included, of which 67 (63%) were male and 39 (37%) were female. Total 36 (34%) had malignant lymphadenopathy, while 70 (66%) had benign lymphadenopathy. Strain Ratio of ≥ 23 was found to be significantly associated with presence of malignant disease with p value of 0.003. At cut off ≥ 23, the Sensitivity, specificity, positive and negative predictive value were 86.11%, 58.57%, 51.67% and 89.13% respectively in predicting malignant lymph nodes on EUS along with diagnostic accuracy of 67.92% (p-value ≤ 0.001).
Conclusion: SR-elastography with EUS can be helpful in differentiating benign from malignant lymph nodes at a cut-off ≥ 23 with a diagnostic accuracy of 67.92%. However, further studies are needed to validate this ratio.
Endoscopic Ultrasound; Strain ratio; Lymph node
Bajaj K, Khan RTY, Tasneem AA, Ismail H, Ur Rehman Siddiqui A, ul Haq M, et al. Diagnostic Accuracy of Strain Ratio
Elastography on Endoscopic Ultrasound in Detecting Malignant Abdominal Lymph Node Using Fine Needle Biopsy
as a Gold Standard. J Gastroenterol Hepatol Endosc. 2021; 6(3): 1103..